How Safe is Choking in Judo?

by E. K. Koiwai, M.D.

ABSTRACT: Shime-waza or the "choke hold," when property applied, should not
cause death; therefore, its primary purpose should be to subdue violent
suspects. When properly applied, the choke hold causes unconsciousness in 10-20
seconds. No fatalities as a result of shime-waza have been reported in the sport
of judo since its inception in 1882. Among the methods of "control holds" taught
to law enforcement officers is the choke hold similar or identical to shime-waza
used in judo. Using the choke hold, officers may afford themselves maximum
safety while subjecting the suspect to a minimum possibility of injury. The
author has reviewed 14 fatalities with autopsy findings where death was
allegedly caused by the use of choke holds.

The "choke holds" known as shime-waza used in the sport of judo have been
taught and used by law enforcement officers to subdue violent suspects.
Recently, however, there have been reports of deaths allegedly caused by the use
of choke holds, which have led to class action suits against its use from local
to state to the U.S. Supreme Court. Apparently, the use of choke holds was
thought to be a safe and harmless way of controlling and subduing violent
suspect s without the use of weapons. The use of choke holds or shime-waza in
judo is similar or identical to the techniques used by the law enforcement
officers.

Investigations have shown that no deaths had occurred by these techniques
since the sport of judo was founded by Professor Jigoro Kano in 1882 in Tokyo,
Japan. A survey made by this author in 1979, based on a questionnaire to all
International Judo Federation (IJF) country members, revealed that although
there were 19 judo fatalities, none was due to shime-waza.

The statistics in the use of shime-waza have been kept by the International
Judo Federation on World Class Judo Championships, Olympics (Munich-1972,
Montreal-1976, Moscow-1980, and Los Angeles-1984), World Judo Championships
(Mexico City-1969, Ludwigshafen-1971, Lausanne-1973, Vienna-1975, Paris-1979,
and Maastricht- 1981), and the Junior World Judo Championships in Rio de
Janiero-1974. Of the 2198 techniques used to score, 97 were shime-waza (4.41%).
No fatalities were recorded.

As of 1985, 113 countries are members of the IJF. All these federations have
numerous tournaments at local, regional, national, and international levels
where shime-waza is used.

In 1981, a class action suit was brought against the City of Los Angeles
regarding fatalities allegedly caused by the "bar-arrn" and carotid artery
control holds. The control holds used are similar to the shime-waza used in
judo. Since no death has been reported in the sport of judo. other studies on
cases of deaths allegedly caused by the use of choke holds had to be
investigated.

Case 1 - 5/75

The strong decedent, who was a black male, age, 25-30, 111.4 kg, height 195.6
cm, resisted violently, The two officers used their batons and physical holds
(choke) to handcuff and place leg restraints on the decedent. He was transported
to the police station where on arrival no pulse could be found. He was then
rushed to the hospital where doctors could not find any vital signs.

The reported cause of death was asphyxiation as a result of manual
compression of neck.

Case 2 - 8/75

The decedent, who was a white male age 21, 52.3 kg, height 185.4 cm, was
reported to have taken lysergic acid diethylamide (LSD) four days before his
death. The arresting officer applied "restraint" on the man's neck. The decedent
was transported to the police station in a convulsive state, then collapsed and
did not respond to stimuli.

The reported cause of death was not only mechanical asphyxia but also by
compression of the vascular circulation to the brain.

Case 3 - 11/75

An altercation ensued with the decedent, who was a black male age 28, 80.9
kg, height 177.8 cm, and the police. The officers tried to apply an approved
type of choke hold and the decedent became unconscious at the scene.

The reported cause of death was acute cardiorespiratory arrest as a result of
compression of the neck. The other significant condition was acute
heroin-morphine intoxication.

Case 4 - 10/76

The suspect, who was a black male age 19, 72.7 kg, height 181.6 cm, was in
custody of the police as a possible case of angel dust inhalation. The arresting
officer used a neck hold to restrain the suspect. He had cardiorespiratory
arrest in the back seat of the police car. Cardiopulmonary resuscitation (CPR)
was instituted. The paramedics found the decedent in agonal rhythm with vomitus
in his mouth. CPR used in the field and at the emergency room was not effective.
The autopsy findings were:

The reported cause of death was asphyxiation to neck restraint procedure for
abnormal behavior associated with phencyclidine (PCP) use. Other significant
conditions were aspiration of vomitus and sickle cell disorder.

Case 5 - 7/77

After being legally arrested for teroristic threats and creating a turmoil,
this white male, age 25, 71.8 kg, height 180.3 cm, was placed in the rear of the
police car. He kicked out the rear window, exited through the broken window, and
continued to kick and strike at the officer. The decedent was subdued by an
officer who, using his flashlight as a choke stick, grabbed the subject about
the neck and tried to choke him while bringing him down to the ground. The
subject continued to fight; consequently, the officer rolled him over on his
stomach and continued to keep "hold" on him until the subject was handcuffed.
The "hold" on him was repeated when the subject started to fight again. Finally,
the subject was placed in a police wagon, with wrists and ankles handcuffed,
face down. The subject was transported to an emergency room; however, after he
was placed on a wheel chair, he was found to be unconscious and was finally
pronounced dead.

The reported cause of death was cardiorespiratory arrest caused by asphyxia
as a result of strangulation and aspiration of gastric contents.

Case 6 - 1/78

The subject, who was a black male age 21, 81.8 kg, height 185.4 cm, was taken
into custody for possibly being under the influence of PCP and reckless driving.
The police had to use neck restraint in the arresting procedure. He was taken to
jail, but then broke the restraints and had to be restrained again. Later in the
evening, in his cell, he was found not to be breathing. Then he was taken to the
hospital and was pronounced dead on arrival (DOA).

The reported cause of death was sudden cardiorespiratory collapse in a
psychotic patient with severe stress and exhaustion after prolonged
combativeness, sleeplessness, and refusal to take nourishment.

Case 7 - 2/78

The decedent, a black male age 34, 72.3 kg, height 177.8 cm, was combative
while being arrested, so a bar arm control hold was used. He kicked the driver
during transport, and, at the station, restraints were used and a bar arm
control hold had to be used again. He was transported to another jail which had
padded cells. During transport he was placed on a gurney, face down, but the
subject appeared to be unconscious at that time. He was placed in a padded cell,
but at that time the subject was not breathing. He was transported to the
dispensary where all attempts failed to revive him.

The reported cause of death was asphyxia as a result of neck compression
during restraining procedure. The other significant condition was interstitial
myocardial fibrosis.

Case 8 - 7/78

The decedent, a black male, age 39, 58.6 kg, height 170.2 cm, had a family
dispute, then turned on the officer on the scene, and the subject was eventually
subdued by a "regular choke hold." When he became unconscious, he was cuffed and
carried outside; he was still unconscious as the rescue ambulance arrived. He
was pronounced dead on arrival at the hospital.

The reported cause of death was asphyxia as a result of neck compression
during restraining procedure.

Case 9 - 1/80

The subject, a white male, age 32, 61.4 kg, height 172.7 cm, was stopped for
a traffic violation. Getting out of the car, he brandished a knife The officers
subdued him with a choke hold and placed him in the police car. At this point,
he "passed out." He was transported to the hospital and died while in custody.
The subject was a suspected drug dealer and abuser.

The reported cause of death was hypoxic encephalopathy as a result of
respiratory arrest following struggle with police officers while in a state of
acute ethanol and cocaine intoxication.

Case 10 - 3/80

The subject, a black male, age 41, 66.2 kg, height 167.6 cm, was in the lobby
of a hotel, yelling and screaming at an off-duty officer. The officer applied a
"bar arm control hold" on the decedent and he "went down." The paramedics were
called and worked on the subject at the scene. They then transported him to a
hospital where he was pronounced dead.

The reported cause of death was acute cardiorespiratory arrest as a result of
carotid control hold of neck. The other significant condition was non-specific
cardiomyopathy.

Case 11 - 3/82

The decedent, a white male age 21, 81.8 kg, height 182.9 cm, an apparent
psychotic inmate in jail, put up a tremendous struggle several times, and was
finally subdued by four detention officers. One applied a carotid artery choke
hold "not more than 20 seconds," and the subject was placed in leather
restraints attached to a cell bunk, face down. The inmate stopped struggling,
developed a weak pulse and shallow breathing, and became cyanotic. A nurse and
paramedics were called. He was resuscitated by the paramedics but expired a few
days later in the hospital.

The reported cause of death was hypoxic encephalopathy, probable forearm
strangulation.

Case 12

During the 1981 Sixth International Judo Federation (IJF) Medical Symposium
in Maastricht, Netherlands, 31 Aug. 1981, Kjell Salling of Norway called
attention to a fatal case as a result of choking. The death was reported in
Paris, France, June 1954. The accident was published and reported by newspapers,
Le Parisien Libere and France-Soir on 24 June 1954. The incident was also
reported in the Official Bulletin of the French Judo Federation. Investigation
revealed that the death was not in the sport of judo, but a method called "Vo et
Vat" taught by a Vietnamese instructor. Vo et Vat was estimated to be a more
violent form of judo. The method was not recognized by the French Judo
Federation and the instructor was not a member of that organization.

The subject was a 34 year old male Vietnamese Vo et Vat instructor who was
"choked" by one of his own students, age 17. For demonstration purposes, the
student was ordered by the instructor to use all his strength when he applied a
reverse cross choke (gyaku jujime). This choke is applied from above with the
instructor lying on his back on the mat. The instructor was going to demonstrate
a method of resistance and counter attack. The instructor was not able to
counter attack, and the student, after the passing of "some minutes," exhausted
by his effort, terminated the "choking." The instructor apparently died on the
mat. Hs demise was witnessed by his students, who were sitting around the two
demonstrating. A doctor was summoned, but he could only state that the
instructor was dead. The autopsy findings were published in the Annales de
Medicine Legale.

The reported cause of death was not only by mechanical asphyxia but also by
compression of the vascular circulation to the brain.

Case 13

A 58-year-old retired janitor suffered cardiac arrest two years before and
was successfully resuscitated, but showed evidence of hypoxic brain damage which
caused personality changes. He was committed to a mental hospital because of
withdrawn behavior. He had arteriosclerotic heart disease; his electrocardiogram
(EKG) showed premature ventricular contractures which was partially controlled
by quinidine.

When an order was granted, two police officers were dispatched to his home to
bring him to the hospital. Coaxing by the police officers proved futile. In an
attempt to overpower and handcuff him, one officer stepped behind the victim and
grabbed him about the neck. The hold intended by the officer was the carotid
sleeper with the neck of the victim in the crook of the arm and forearm of the
officer. After a brief but violent struggle, during which both the officer and
victim fell to the floor, the victim became lifeless. He did not respond to CPR.
An EKG taken during resuscitation showed cardiac arrest. Witnesses, including
family members, stated that the entire struggle lasted only a "short time," with
the neck hold in place several seconds.

The reported cause of death was cardiac arrest, arteriosclerotic hypertensive
heart disease, and neck compression, contributory, classified as homicide.

Case 14

A 35-year-old manual laborer was taken into custody for threatening his wife
with a shotgun. He had been treated on many occasions for manic depressive
psychosis and had been on maintenance dose of lithium. On the third day in jail,
although on lithium, he became combative, disruptive, and threatened the life of
another prisoner. He resisted the restraining attempt of six guards, but was
finally overpowered and handcuffed and moved to a solitary confinement cell
where he remained violent and combative.

He was forced face down on the bunk while the handcuffs were removed and
replaced by nylon flex cuffs. During this time, a guard put the victim's head in
a neck hold which the guard described as the carotid sleeper. The prisoner
ceased to struggle aand the guards left him to recover. A few minutes later when
a guard returned to check on the prisoner, the prisoner was found apneic. CPR
was immediately begun, and in a matter of minutes medical personnel arrived at
the scene. EKG showed fine ventricular fibrillation which progressed to cardiac
standstill.

The reported cause of death was neck hold.

Choke Holds Used by the Police

The Carotid Takedown Modified and Control

A right-handed officer maneuvers behind the suspect, wraps his right arm
around the suspect's neck between the throat and the carotid. At this point,
pressure is applied to the suspect's neck between the throat and the carotid
artery with the lower forearm. The suspect is then pulled backwards so that the
suspect's back is in contact with the officer's chest. The technique is the same
as hadakajime used in judo in the standing position. The suspect is then pulled
down to a sitting position. If the suspect continues to resist, the move is made
to go into the "locked carotid control." The officer can do this by driving the
right thumb into the left armpit, then griping the upper left arm with the right
hand. The right arm is flexed and the left hand is extended beyond the right
shoulder. This maneuver will draw the officer's right arm tighter around the
neck.

The Bar Arm Takedown and Control

In the event that the suspect is uncontrollable and the officer is unable to
apply the modified carotid hold, the officer may have to resort to the bar arm
to take the suspect down. The locked bar arm control is performed by gripping
the left biceps with the right hand. At the same time, the officer bears down
with the left and against the back of down to a sitting position with the same
maneuver as the carotid takedown and control. This technique is the same as the
one method of hadakajime (naked choke-lock) used in judo.

It is important to point out that the police training manuals emphasize that
the application of pressure must be stopped as soon as the suspect ceases
resisting or goes limp. When a situation escalates to the point that a control
hold is necessary to restrain and control a suspect, both the officer and the
suspect are prone to injury. It is preferable to use persuasion and command
presence to control a situation. When it does become necessary to apply a
control hold, proficiency with the control holds described will help to restrain
a combative suspect.

Discussion

The 14 fatalities presented were allegedly caused by "choke holds", 13 by law
enforcement officers, 1 by a student learning Vo et Vat, a Vietnamese version of
judo. In the sport of judo, which started in 1882, no fatalities have been
reported. Judoists are taught to apply shime-waza using the principle "maximum
efficiency with minimum effort." The maximum pressure is applied directly on the
"carotid triangle" without applying the pressure on other parts of e neck,
causing unnecessary damage. In all 14 cases, this author has noted evidence of
injuries to the structures of the neck from bruises, ecchymosis, hemorrhages to
fractures of the cartilage of the neck (Cases 1, 5, 10, 13, and 14), and
intervertebral discs (Case 7). Submucosal or mucosal injuries are noted in the
larynx in Cases 1, 2, 6, 11, and 13, All these findings indicate that tremendous
force was exerted on the necks of the suspects.

If the carotid artery hold is properly applied, unconsciousness occurs in
approximately 10 seconds (8-14 seconds). After release, the subject regains
consciousness spontaneously in 10-20 seconds. Neck pressure of 250 mm of Hg or 5
kg of rope tension is required to occlude carotid arteries. The amount of
pressure to collapse the airway is six times greater.

Anatomically, the anterior cervical triangle of the neck contains the
superior carotid triangle. The pressure can be applied to either side. The
anterior cervical triangleis a triangle bordered by the sternocleidomastoid
muscle (large neck strap muscle) laterally, the mandible jaw bone above, and
medially by the cervical midline, a line drawn from the tip of the jaw to the
sternal notch. Within the anterior cervical triangle, there are three smaller
triangles:

submandibular (submaxillary or digastric)

superior carotid

inferior carotid (muscular).

In the technique of choking, the most important triangle is the superior
carotid which contains important structures. This triangle is bordered by the
stylohyoid and the posterior belly of the digastric muscle above, the anterior
border of the sternocleidomastoid muscle medially. Within the superior carotid
triangle are the common carotid artery and branches, the carotid bodies,
internal jugular vein, vagus nerve and branches, superior laryngeal nerve, and
cervical sympathetic trunk.

Overlying this superior carotid triangle is only skin, superficial fascia
which usually are thin although there may be an appreciable amount of
subcutaneous fat. Within the superficial fascia is an exceedingly thin
(paper-thin) muscle, platysma muscle, which begins in the tela subcutaneous over
the upper part of the thorax, passes over the clavicle (collar bone), and runs
upward and somewhat medially in the neck and across the mandible to blend with
superficially located facial muscles. The platysma muscle has no very important
action, but will wrinkle transversely the skin of the neck and help to open the
mouth. 'This muscle does not protect the underlying vital structures.

Consequently, the amount of pressure directed to the superior carotid
trianile needs to be no more than 300 mm Hg to cause unconsciousness in an
adult. A female can, if the choke is properly performed, without great strength
"choke out" a male twice her size.

The state of unconsciousness, according to the investigators of the Society
for Scientific Study in Judo, Kodokan, is caused by a temporary hypoxic
condition of the cerebral cortex. In judo, the player holds the opponent's neck
by his hands (forearm) or judogi, the bloodflow of the common carotid artery is
obstructed, but the vertebral artery is not obstructed. It has been confirmed
that complete obstruction of blood flow to the brain or asphyxia by complete
closure of the trachea will result in irreversible damage to the body which
often results in death. While unconsciousness (ochi) caused by choking (shime)
in judo is a temporary reaction which incapacitates the opponent for a short
while, its execution is quite harniless.

Experiments with human subjects and animals show the following effects from
"choking":

Unconsciousness is due to lack of oxygen and by the metabolites created in
the brain as a result of:

Acute cerebral anemia by pressure on:

common carotid artery

occipital artery

jugular vein

Shock, reflex action initiated on the receptor organ in the carotid
sinus.

The appearance of flushing of the face because of the disturbances in
pressure in the carotid arteries and jugular veins.

Decrease blood flow of the face shown by ultrasonic and laser-Doppler
blood flow monitoring devices. The mean value is 89.4% with the lowest point
in 6 seconds; after release return normal in 13.7 seconds.

Decrease oxygen saturation in blood in the helix of the ear by using an
ear oximeter. Down from 95 to 86% and reach a minimum of 82% in 2-4 seconds.
After regaining consciousness return to 90 to 92%. Sixty percent oxygen
saturation in the brain causes unconsciousness.

Tachycardia hypertension, and mydriasis (dilated pupils) are caused by
stimulation of the sympathetic nervous system (vagus nerve). The systemic
pressure rises 30-40 mm of Hg. After release the blood pressure returns to
normal in 3-4 minutes.

In some cases bradycardia and hypotension occur while other cases show
tachycardia and hypertension depending on the hypersensitivity of the carotid
sinus and where the pressure was applied.

Cardiac volume decreases but the volume recovers in 10 seconds after
awakening.

The peripheral blood vessels are also involved: dilatation of muscle
vessels and constriction of skin vessels. In shock, accompanied by
unconsciousness, bradycardia and hypotension are observed with dilation of
muscle vessels.

Choking acts as a stressor on the circulatory and
hypophysio-adrenocortical system:

Decreased blood volume and increased plasma proteins as a result of
increased permeability of blood vessels. This is similar to unconscious
state following electric shock.

No change in the hematocrit value or albumin/globulin.

A temporary increase in eosinophiles, then after awakening, there is a
decrease in number after 4 hours.

The 17-ketosteroids in the urine: 2 hours after recovery, the amount is
very much increased then gradually decreased (lasts 6-8 hours).

The electroencephalogram (EEG): convulsions that appear in the unconscious
stage are very similar to those of petit mal of epilepsy. No deleterious
effects remained after the use of the choke hold. It is considerable less
dangerous than a knockout in boxing.

Conclusion

The effects of carotid artery hold or shimewaza have been studied
extensively. However, the use of this hold by law enforcement officers has
resulted in deaths. The police department training manuals emphasize that
control hold should be used only when necessary to stop a suspect's resistance
and not necessarily to cause unconsciousness.

The enforcement officers, although trained, have great difficulty in subduing
violent and uncooperative suspects. Some suspects are under the influence of
drugs: Case 3, acute heroin-morphine intoxication; Case 4, phencyclidine (PCP);
and Case 9, acute ethanol and cocaine intoxication. These suspects may have had
greater tolerance for pain, thus making it more difficult to restrain them and
to recognize whether the state of unconsciousness is due to drugs rather than to
the restraining holds. In other words, these suspects were not cooperative.

In judo, the participants are taught to "choke" properly and in turn have
been "choked" and have the ability to realize its effects before unconsciousness
ensues. The officials, referee, judges, and coaches can recognize the player
when he is "choked out" (becomes unconscious). If enforcement officers are to
use the choke holds to subdue violent suspects as a last resort, they should be
properly trained and supervised by trained certified judo instructors. Then
possibly there will be less misuse or abuse of the techniques of choking which,
when used improperly, result in fatalities.

The number of fatalities resulting from the use of choke holds will decrease
if the following procedures are followed:

Choke holds to be taught by trained and certified instructors:

to be familiar with the anatomical structures of the neck and where the
pressure is to be applied (carotid triangle)

to know the physiology of choking, that only a small amount of pressure
is needed to cause unconsciousness

to recognize immediately the state of unconsciousness and to release the
pressure immediately.

to learn proper resuscitation methods if unconsciousness is prolonged

to prevent aspiration of vomitus and not to place the restrained suspect
face down. Keep the suspect under constant observation.

To revise the police training manuals to emphasize the above procedures.
These are the procedures and principles taught by judo instructors which have
prevented deaths caused by shime-waza in the sport of judo for over 100 years.

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